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They are most frequently seen in the cervical and lumbar regions, far more frequently than in the thoracic spine 6.

This article specifically relates to spinal schwannomas. For a general discussion of schwannomas (epidemiology, pathology and general radiographic features), refer to schwannoma and spinal nerve sheath tumours.

Clinical presentation

Patients commonly present with pain. As spinal schwannomas usually arise from the dorsal sensory roots, radicular sensory changes also occur. Weakness is less common. Myelopathy may occur if the lesion is large.

Most spinal schwannomas are solitary and sporadic, however there is an association with neurofibromatosis type 2 (NF2). In patients with NF2, almost all spinal nerve root tumours are schwannomas or mixed tumours.

Radiographic features

Schwannomas are in most instances indistinguishable from neurofibromas. As such please refer to the article on spinal nerve sheath tumours for a discussion of their radiographic appearance.

In general schwannomas appear as rounded lesions, often with associated adjacent bony remodelling. when large they may either align themselves with the long axis of the cord, forming sausage shaped masses which can extend over several levels, or may protrude out of the neural exit foramen, forming a dumb-bell shaped mass.

Treatment and prognosis

Schwannomas are slow growing lesions but can nevertheless be debilitating. They almost never undergo malignant change. Surgery is the treatment of choice. Gross total resection is usually curative for patients with sporadic tumours. For patients with NF2, there is a high incidence of new tumour formation.